A meta-analysis of risk factors for lymph node posterior to the right recurrent laryngeal nerve metastasis in papillary thyroid carcinoma

Zhou, Tianhan; Wu, Fan; Zhao, Lingqian; Jiang, Kecheng; Luo, Dingcun

doi:10.21037/gs-21-177

Cited by 4 publications

(6 citation statements)

References 19 publications

(39 reference statements)

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“…This study did not find a significant association between gender, age, tumor size, uni-multifocality, prelaryngeal lymph nodes metastasis, left CLN metastasis, and LN-prRLN metastasis. However, a significant association was reported by previous studies on PTC (14)(15)(16)(17). Using univariate and multivariate analyses, we confirmed that ETE, lateral lymph node metastasis, the number of metastatic LN-arRLN were independent predictors of LN-prRLN metastasis, which was consistent with previous reports (6,14,15,18).…”

Section: Discussionsupporting

confidence: 92%

“…However, a significant association was reported by previous studies on PTC (14)(15)(16)(17). Using univariate and multivariate analyses, we confirmed that ETE, lateral lymph node metastasis, the number of metastatic LN-arRLN were independent predictors of LN-prRLN metastasis, which was consistent with previous reports (6,14,15,18).…”

Section: Discussionsupporting

confidence: 92%

“…From previous studies, the rate of LN-arRLN metastasis is about 8.65-19.8% ( 12 – 14 ). In this study, LN-arRLN metastasis was observed in 51.8% (291 of 562) of patients, while LN-prRLN metastasis was found in 30.4% (171 of 562).…”

Section: Discussionmentioning

confidence: 95%

“…In several studies, LN-arRLN metastasis has been proven to be an important factor for LN-prRLN metastasis in PTC ( 6 , 14 ). In this study, the risk of LN-prRLN metastasis was almost twice higher in patients with LN-arRLN metastasis than those without, indicating that the LN-arRLN compartment could serve as an intraoperative factor for predicting LN-prRLN metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Pattern and Predictive Factors of Metastasis in Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in Papillary Thyroid Carcinoma

Zhou

Duan

et al. 2022

Front. Endocrinol.

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ObjectiveThe right cervical central lymph nodes include lymph nodes anterior to the right recurrent laryngeal nerve (LN-arRLN) and lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN), and are separated by the right recurrent laryngeal nerve (RLN). LN-prRLN is a common site of nodal recurrence after the resection of papillary thyroid carcinoma (PTC). However, the complexity in anatomical structure brings difficulties in determining the surgical scope, so it is necessary to assess the pattern and predictive factors of right cervical central lymph nodes, especially LN-prRLN metastasis in papillary thyroid carcinoma.MethodsA total of 562 diagnosed PTC patients who underwent right or total thyroidectomy were enrolled in this retrospective study. The clinicopathological features were collected, univariate and multivariate analyses were performed to determine predictive factors of the right central lymph node metastasis.ResultsIn this study, the metastatic rates of the right CLN, the LN-arRLN and the LN-prRLN were 59.6% (335/562), 51.8% (291/562) and 30.4% (171/562), respectively. And 22.6% (127/562) of patients had both LN-arRLN and LN-prRLN metastasis. Among patients without LN-arRLN metastasis, the rate of LN-prRLN metastasis was 16.2% (44/271), accounting for 25.7% of the LN-prRLN metastasis group. Factors associated with an increased risk of LN-arRLN metastasis include male, age below 55 years, tumor size > 1cm, extrathyroidal extension (ETE), clinical lymph nodes metastasis(cN1), lateral lymph node metastasis, and left CLN metastasis. In addition, ETE, lateral lymph node metastasis, and LN-arRLN metastasis were independent factors of LN-prRLN metastasis. The predictive factors of LN-prRLN in cN0 PTC were further explored, revealing that tumor size ≥1.5cm, ETE, and LN-arRLN metastasis were independent predictors of LN-prRLN metastasis in cN0 PTC.ConclusionThe LN-prRLN should not be ignored in surgery because of its high rate of metastasis. Our findings indicate that thorough dissection of central lymph nodes, especially LN-prRLN is crucial in clinical work.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Pattern and Predictive Factors of Metastasis in Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in Papillary Thyroid Carcinoma

Zhou

Duan

et al. 2022

Front. Endocrinol.

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“…Therefore, Area VI B dissection is necessary for patients with right-sided thyroid cancer. In a meta-analysis, Zhou et al ( 27 ) found that patients younger than or equal to 45 years old were more likely to develop Area VI B metastasis, and the number of lymph node metastasis in this region was related to the impaired survival of young patients ( 28 ). In our study, the average age of patients was not more than 35 years old.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of different approaches to dissection of lymph nodes posterior to right recurrent laryngeal nerve: a retrospective comparative cohort study of endoscopic thyroidectomy via the areolar approach and via the axillo-breast approach

Si¹,

Mei²,

Wang³

et al. 2022

Gland Surg

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Background: The American Thyroid Association (ATA) points out that lymph nodes posterior to right recurrent laryngeal nerve (LN-prRLN) should be routinely dissected. Due to the high risk of nerve injury, the lymph nodes in this area are difficult to dissect thoroughly. Although there are many approaches to endoscopic thyroidectomy, no study has been conducted on which one is more suitable. The purpose of this study was to evaluate the safety, thoroughness, related trauma, and feasibility of two widely used endoscopic thyroidectomy approaches, so as to provide a basis for the surgeon to select a better surgical approach.Methods: This retrospective study included patients who underwent ETA (n=26) and ETAB (n=36). All patients had a pathological diagnosis of papillary thyroid carcinoma (PTC) and underwent endoscopic right thyroidectomy from May 2015 to February 2022 in the Affiliated Hospital of Nantong University. The basic clinical data and surgical outcomes of the two groups were compared.Results: There was no statistical difference between the two groups in basic clinical data and oncological characteristics, which meant that the baseline data of the two groups of patients were comparable. Significant statistical significance was observed in the operation duration (149.38±44.15 vs. 119.22±45.48 min, P=0.011), drainage volume 24 h after operation (95.54±16.79 vs. 54.46±15.11 mL, P<0.001), visual analog score (VAS) 24 h after operation (3.69±1.44 vs. 2.25±1.32, P<0.001), hospitalization duration after the operation (3.19±0.75 vs. 2.25±0.44 days, P<0.001), number of lymph node dissections after right recurrent laryngeal nerve resection (0.96±1.08 vs. 2.06±1.77, P=0.007), and number of lymph node metastases after right recurrent laryngeal nerve resection (0.12±0.33 vs. 0.58±1.00, P=0.025). Besides, there was no significant difference in the numbers of central lymph node dissections and central lymph node metastases.Conclusions: Our study indicated that compared with ETA, ETAB may perform a more efficient dissection of the LN-prRLN based on less surgical trauma, which could provide a basis for the surgeon to select a better surgical approach.

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Preoperative Prediction of Metastatic Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in cN0 Papillary Thyroid Carcinoma

Shao,

Wang,

et al. 2024

CMAR

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The advantages of the dissecting the metastatic lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) remain a great deal of controversies in papillary thyroid carcinoma (PTC) patients without clinical evidence. The purpose of our retrospective research was to investigate the predictive factors of the LN-prRLN in cN0 PTC patients. Methods and Materials: Altogether 251 consecutive cN0 PTC participants accepted unilateral or bilateral thyroidectomy accompanied with LN-prRLN dissection between June 2020 and May 2023 were included in the research. Then, univariate and multivariate logical regression analysis were conducted to analyze the relationship between the LN-prRLN and these predictive factors, and a predictive model was also developed. Surgical complications of LN-prRLN dissection were also presented. Results:The rate of LN-prRLN was 17.9% (45/251) in cN0 PTC patients after the analysis of postoperative histology. The age <55 years, multifocality, microcalcification, and BRAF V600E mutation were identified to be predictive factors of LN-prRLN in cN0 PTC patients. The risk score for LN-prRLN was calculated: risk score = 1.192 × (if age <55 years) + 0.808 × (if multifocality) + 1.196 × (if microcalcification in nodule) + 0.918 × (if BRAF V600E mutation in nodule). The rates of the transient hypoparathyroidism and hoarseness were 1.2% (3/251) and 2.0% (5/251), respectively. Conclusion:The age <55 years, multifocality, microcalcification, and BRAF V600E mutation are independent predictors of the LN-prRLN in cN0 PTC patients. An effective predictive model was established for predicting the LN-prRLN in cN0 PTC patients, with the aim to better guide the surgical treatment of PTC. A thorough inspection of the lateral compartment is recommended in PTC patients with risk factors. The multicenter research with long-term follow-up should be carried out to ascertain the optimal surgical approach for patients with PTC.

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A meta-analysis of risk factors for lymph node posterior to the right recurrent laryngeal nerve metastasis in papillary thyroid carcinoma

Cited by 4 publications

References 19 publications

Pattern and Predictive Factors of Metastasis in Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in Papillary Thyroid Carcinoma

Pattern and Predictive Factors of Metastasis in Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in Papillary Thyroid Carcinoma

Surgical outcomes of different approaches to dissection of lymph nodes posterior to right recurrent laryngeal nerve: a retrospective comparative cohort study of endoscopic thyroidectomy via the areolar approach and via the axillo-breast approach

Preoperative Prediction of Metastatic Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in cN0 Papillary Thyroid Carcinoma

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